Incidence and risk factors of unplanned intubation during pediatric sedation for MRI

Abstract

Background: It is often difficult for the pediatric patient to cooperate or to remain immobile during MR scans. Therefore, sedation is usually needed for children. Purpose: To evaluate the incidence and contributing factors of unanticipated intubation during sedation for MRI scan in children.Study Type: Retrospective observational study. Population/Subjects: In all, 1165 charts were reviewed retrospectively of patients who had been sedated by anesthesiologists at a single institution from May 2015 to June 2016. Assessment: Patient's demographics, the region of the MRI scan, total amount of medication, duration of sedation, and any adverse event during MRI were assessed. The adverse events during sedation including airway obstruction, apnea, desaturation, bradycardia, and hypotension were also assessed. Statistical Tests: Risk factors of unplanned intubation during MRI sedation were identified by univariate and multivariate analysis. Firth's exact logistic regression was used for univariate and multivariate analysis. According to the results from multiple logistic regression, a nomogram was developed to predict the risk. Results: A total of 1165 children aged 7 days to 18 years with sedation used during an MRI scan during the study period showed an incidence of unexpected intubation as~2% (n = 23, 95% confidence interval [CI]; 0.0123, 0.0295). Multivariate logistic regression revealed the following risk factors of unplanned intubation: American Society of Anesthesiologists (ASA) class III patients (odds ratio [OR] 1.212, P < 0.001), premature birth (OR 2.317, P < 0.001), and the presence of gastroesophageal reflux disease (GERD) (OR 1.474, P < 0.001) or congenital heart disease (OR 1.118, P < 0.001). Data Conclusion: This study identified risk factors of unplanned intubation as follows: ASA class III patients, premature birth, and the presence of GERD or congenital heart disease. The physician should screen risk factors of unexpected intubation and maintain adequate sedation during MRI scans in pediatric patients. Level of Evidence 3.

Deep Sedation in Lateral Position for Preterm Infants during Cerebral Magnetic Resonance Imaging: a Prospective Observational Study

“…Prematurity is considered one of the most signi cant risk factors for emergency intubation during MR sedation in children. This vulnerability may be attribute to the immaturity of respiratory centers and the increased laxity of the upper airway wall [15]. These characteristics explain the heightened susceptibility of preterm infants to oxygen desaturations during sedation for MR examinations.…”

The utility of the perfusion index as an indicator of anesthetic depth for repeated propofol sedation in children: An observational study

“…Based on these advantages, propofol has provided children with safe and effective sedation in various diagnostic studies and procedures that require sedation. 9,10 In our center, propofol has been safely used not only for children undergoing time-consuming procedures or imaging study such as magnetic resonance imaging and computed tomography scans, 11 but also for proton therapy. In particular, proton therapy is performed under repeated sedation therapy.…”

Pediatric Sedation/Anesthesia forMRI: Results From the Pediatric Sedation Research Consortium

“…Airway obstruction occurred in 14% and 16% of ASD and non‐ASD patients, respectively, while less serious events occurred in 23% and 20%, respectively. Kim et al 13 performed a single institution, retrospective study to evaluate the incidence and risk factors associated with unanticipated intubation during sedation for MRI as provided by anesthesiologists. In this review of 1165 cases, unexpected intubation occurred in 2% of patients.…”